End Of Life In Care Homes

In our society, the overwhelming majority of people die in later life. They typically die slowly of chronic diseases, with multiple co-existing problems over long periods of time. They spend the majority of their final years at home, but many will die in hospitals or care homes. This book explores the possibilities for improving the care of older people dying in residential care and nursing homes. It argues that there are aspects of palliative care that, given the right circumstances, are transferable to dying people in settings that are not domestic or hospice based. End of Life in Care Homes describes what happens in nursing and residential care homes when a resident is dying, how carers cope, and the practical, health and emotional challenges that carers face on top of their day-to-day work. Based on detailed research from both the UK and US, the book shows how the situation can be improved.

This volume outlines the belief that nursing homes can and should support the physical, psychological, and social needs of residents, and that residents can thrive in nursing homes when these needs are met. The book's contributors explore the role that palliative or comfort care plays in enhancing the quality of life of nursing home residents as well as the medical, familial, psychological, cultural, and financial issues that influence decision-making about end-of-life care. The book is designed to be a tool to prepare social workers to advocate for a greater incorporation of palliative care and psychosocial care into the culture of nursing home care. The book includes discussions of the psychosocial needs of nursing home residents and families, the financing of long-term care and end-of-life care, ethical issues in chronic care and end of life, trends and characteristics in nursing home care, rituals and grief at end-of-life, and considerations for the future. Each chapter includes case examples to further illustrate points made.

In this work, contributors from nursing and medicine, from the social and health sciences, and from ethics and health planning provide an international perspective on key issues in relation to end-of-life care such as: assessment; loss, autonomy and the ethics of end-of-life decision making.

The notion of quality of life has for several decades been well-established in ethical debate about health care and the care of older people. Dignity in Care for Older People highlights the notion of dignity within the care of the elderly, focusing on the importance of theoretical concepts. Primarily based on a Research Project, Dignity and Older Europeans, funded by the European Commission, this book provides a thorough investigation of the concept of dignity and related concepts such as quality of life and autonomy. It includes a chapter devoted to the dignity of human embodiment, emphasizing the importance of the notion of the lived body in the context of elderly care. As a result of the conceptual study a model of dignity emerges in which four variants of dignity stand out: dignity of merit, dignity as moral status, dignity of identity and Menschenwürde (the specifically human value). From this follows a discussion of how these variants of dignity can be used in characterizing the care of the elderly. The notions of dignity and dignified care are discussed particularly in relation to demented persons and dying persons. The book also contains a chapter on the dignity of the dead person. International in focus, Dignity in Care for Older People provides a contemporary discussion of the care of older people, and will be of use to qualified nurses and social care practitioners working with older people, as well as those on ethics and gerontology courses.

This open access book aims to provide a comprehensive but practical overview of the knowledge required for the assessment and management of the older adult with or at risk of fragility fracture. It considers this from the perspectives of all of the settings in which this group of patients receive nursing care. Globally, a fragility fracture is estimated to occur every 3 seconds. This amounts to 25 000 fractures per day or 9 million per year. The financial costs are reported to be: 32 billion EUR per year in Europe and 20 billon USD in the United States. As the population of China ages, the cost of hip fracture care there is likely to reach 1.25 billion USD by 2020 and 265 billion by 2050 (International Osteoporosis Foundation 2016). Consequently, the need for nursing for patients with fragility fracture across the world is immense. Fragility fracture is one of the foremost challenges for health care providers, and the impact of each one of those expected 9 million hip fractures is significant pain, disability, reduced quality of life, loss of independence and decreased life expectancy. There is a need for coordinated, multi-disciplinary models of care for secondary fracture prevention based on the increasing evidence that such models make a difference. There is also a need to promote and facilitate high quality, evidence-based effective care to those who suffer a fragility fracture with a focus on the best outcomes for recovery, rehabilitation and secondary prevention of further fracture. The care community has to understand better the experience of fragility fracture from the perspective of the patient so that direct improvements in care can be based on the perspectives of the users. This book supports these needs by providing a comprehensive approach to nursing practice in fragility fracture care.

When the end of life makes its inevitable appearance, people should be able to expect reliable, humane, and effective caregiving. Yet too many dying people suffer unnecessarily. While an "overtreated" dying is feared, untreated pain or emotional abandonment are equally frightening. Approaching Death reflects a wide-ranging effort to understand what we know about care at the end of life, what we have yet to learn, and what we know but do not adequately apply. It seeks to build understanding of what constitutes good care for the dying and offers recommendations to decisionmakers that address specific barriers to achieving good care. This volume offers a profile of when, where, and how Americans die. It examines the dimensions of caring at the end of life: Determining diagnosis and prognosis and communicating these to patient and family. Establishing clinical and personal goals. Matching physical, psychological, spiritual, and practical care strategies to the patient's values and circumstances. Approaching Death considers the dying experience in hospitals, nursing homes, and other settings and the role of interdisciplinary teams and managed care. It offers perspectives on quality measurement and improvement, the role of practice guidelines, cost concerns, and legal issues such as assisted suicide. The book proposes how health professionals can become better prepared to care well for those who are dying and to understand that these are not patients for whom "nothing can be done."

Although the need for improved care for dying patients is widely recognized and frequently discussed, few books address the needs of the physicians, nurses, social workers, therapists, hospice team members, and pastoral counselors involved in care. Care of the Dying Patient contains material not found in other sources, offering advice and solutions to anyone—professional caregiver or family member—confronted with incurable illness and death. Its authors have lectured and published extensively on care of the dying patient and here review a wide range of topics to show that relief of physical suffering is not the only concern in providing care. This collection encompasses diverse aspects of end-of-life care across multiple disciplines, offering a broad perspective on such central issues as control of pain and other symptoms, spirituality, the needs of caregivers, and special concerns regarding the elderly. In its pages, readers will find out how to: effectively utilize palliative-care services and activate timely referral to hospice, arrange for care that takes into account patients’ cultural beliefs, and respond to spiritual and psychological distress, including the loss of hope that often overshadows physical suffering. The authors especially emphasize palliative care and hospice, since some physicians fear that such referrals may be viewed by patients and families as abandonment. They also address ethical and legal risks in pain management and warn that fear of overprescribing pain medication may inadvertently lead to ineffective pain relief and even place the treating team at risk of liability for undertreatment of pain. While physicians have the ability to treat disease, they also help to determine the time and place of death, and they must recognize that end-of-life choices are made more complex than ever before by advances in medicine and at the same time increasingly important. Care of the Dying Patient addresses some of the challenges frequently confronted in terminal care and points the way toward a more compassionate way of death.

"A guide for carers caring for a person who has a life limiting illness at home"--Provided by publisher.